The primary aim of the proposed research is the further development of ADEPT (Assessment of Doctor-Elderly Patient Transactions), an instrument for assessing doctor-elderly patient interaction which will: a. Have acceptable reliability and validity b. Be suitable for use in evaluating medical student communication skills, doctor-elderly patient interaction, and for physician self-assessment of communication skills Five hundred interactions of doctors and their elderly patients will be videotaped for use in this project. Two university based departments will provide 250 interactions, and a managed care organization will provide 250 interactions. Patient and physician characteristics will be gathered for each interaction. Additional, follow-up patient interviews will assess patient satisfaction, understanding, compliance, health status, and cost of care to be measured as health services utilization. The videotapes will be archived at Saint Louis University as a database for researchers studying doctors and elderly patients following this project. ADEPT will be applied to these videotapes as a means of further confirming the psychometric properties of ADEPT and its ability to predict patient outcomes. Audiotapes of the interaction will be coded in the Roter Interaction Analysis System and Multi Dimensional Interaction Analysis system for a comparison of performance characteristics. PROPOSED COMMERCIAL APPLICATION: ADEPT has been designed for two purposes. The first is as an assessment tool to be used in teaching and clinical settings to assess the interaction skills of physicians. The second is as a research instrument for studying how doctors and elderly patients interact. There will be three markets for ADEPT --medical educators, the research community and managed care organizations. ADEPT will be marketed in both a training format and a quality assurance format.